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Biomedical subjects

S S Sharfstein

Publications and source records attributed to S S Sharfstein.

At least 19 recordsLinked to original sources
PubMed1995

The role of private insurance in financing treatment for depression.

The health care system in the United States is expensive but fails large groups of its citizens, particularly those with serious mental illness. This paper examines the resource implications of adequate treatment for depression. An analysis of the various tasks necessary for a proper treatment program is used to indicate places where the current mechanisms of provision fall short. Appropriate innovations in principles of funding are suggested.

Costs and Cost Analysis↗
PubMed1994

Campaign contributions from the American Medical Political Action Committee to Members of Congress. For or against the public health?

BACKGROUND: The American Medical Political Action Committee (AMPAC), the political arm of the American Medical Association (AMA), contributed $2.4 million to candidates for Congress during the 1989-1990 campaign and $2.9 million during the 1991-1992 campaign. It is not known whether these funds preferentially benefited representatives who supported the AMA's positions on public health issues. METHODS: We analyzed AMPAC contributions to members of the House of Representatives during the 1989-1990 and 1991-1992 campaigns according to their votes on three health-related issues: the promotion of tobacco exports, the institution of a mandatory waiting period before a handgun purchase, and the so-called gag rule, which limited physicians' speech on abortion in federally funded clinics. For each issue, we determined whether AMPAC had contributed more on average to opponents or to supporters of the official AMA position. RESULTS: AMPAC contributed more on average to opponents of the AMA positions on all three public health issues. From 1989 to 1992, AMPAC gave significantly larger average contributions to House members who favored tobacco-export promotion than to those opposed it ($11,549 vs. $9,842, P = 0.04) and contributed significantly less on average to supporters of handgun control than to their opponents ($9,022 vs. $11,250, P = 0.001). During the same period, AMPAC's contributions revealed a marked preference for House members who supported the gag rule over those who opposed it ($10,961 vs. $9,611, P = 0.05). House members who supported the AMA positions on all three votes received an average of $8,800 from AMPAC from 1989 through 1992, whereas members who opposed all three positions received an average of $13,270 (correlation between the number of votes for AMA positions and AMPAC contributions, -0.21; P < 0.001). CONCLUSIONS: AMPAC's contributions to members of the House of Representatives belie the AMA positions on some important public health issues.

American Medical Association↗
PubMed1994

Economics redefining the practice of psychiatry.

Major economic forces are dramatically affecting the practice of psychiatry. In the light of these changes, the author suggests how psychiatrists can have an expanded role in the emerging outcome-driven world of health care.

Deinstitutionalization↗
PubMed1993

Psychiatric care and health insurance reform.

Concerns about cost, access, and quality of health care in the United States have led to a variety of legislative proposals that would reform our health care system and its financing. Health insurance benefits for mental illness, including substance abuse, are treated differently from medical/surgical benefits, with stricter limits on outpatient visits and hospital days. Medicare, Medicaid, and most private health insurance plans contain this historic disparity of coverage for mental illness compared to general medical illness. Psychiatric services are also distinguishable because of the large public sector reimbursement for mental illness treatment and support. Principles for a more equitable design of mental health benefits include a non-discriminatory approach; payment on the basis of service rather than diagnosis; application of cost containment for care of mental illness on the same basis as care of general medical illness; retention of the public sector as a backup system for high-cost, long-term care; encouragement of lower-cost alternatives to the hospital through the development of a continuum of care; and a recognition of the distinction between psychotherapy and medical management. All current approaches to universal health care fall short of these principles. A research agenda is needed now more than ever in order to articulate the case for complete coverage of mental illness and substance abuse.

Ambulatory Care↗